Mr. Rutherford, former director and founder of the practice management department of the AUA, has been a thought leader and writer on urology management for more than 20 years.
Adoption of new technology has always been a common characteristic in the specialty of urology. One need only take a brief tour of the William P. Didusch Center for Urologic History at the AUA headquarters in Linthicum, MD to be impressed with the technological advancement in the diagnosis and treatment of urologic conditions over the decades. In particular, digital health technology has been sweeping through all health care delivery systems in the past few years. “Adoption of these emerging technologies, while favorable, will require a high level of coordination and interoperability across the various sectors of health care,” according to a post on www.quora.com.
Urologists and their practice management teams are bombarded with new technological breakthroughs each spring at conferences such as the AUA annual meeting and AUA section meetings. This year, two examples include a high-frequency quantitative ultrasound system using a new micro-ultrasound scanner for identification of possibly cancerous prostate lesions (Ultrasound Med Biol April 4, 2018 [Epub ahead of print]) and a portable, diagnostic cystoscope with a self-contained, reusable video electronics handle and a detachable, single-use cannula with LED and high-resolution camera at the tip.
Urologists frequently become enamored by the research and the unique characteristics of new technology. The business management team must ask the hard questions. What are the practical considerations in deciding when a practice or a hospital should move to implement some of these advanced devices?
The following is a list of six criteria that should be considered prior to acquisition of new technology:
Is it FDA approved? In the U.S., no payer can pay for use of unapproved devices. This is a prerequisite for Medicare to approve an allowable fee for a new service, and this protocol is followed by all other government and commercial payers.
What is the procedure’s current reimbursement status among your major payers? Even an FDA-approved device may still be considered “investigational” by payers for a period of time, particularly if it is a technological improvement on existing treatments. Being an early adopter can wreak financial damage if providers have to convince patients to pay out of pocket for this new, improved treatment that is not covered by insurance.
How will the return on investment be affected by declines in reimbursement rates over time? Savvy practice managers who have years of experience with insurance payments realize that when a new CPT code is adopted by the American Medical Association and valued for payment by the Centers for Medicare & Medicaid Services (CMS), the reimbursement per treatment typically falls. This decline is generally based on declining estimates of practice expense and liability insurance expense as new technology becomes state of the art.